非医学大学生干部急救知识和技能培训效果分析

[目的]对我校非医学大学生干部进行院前急救知识培训,力争做到以点带面,使每个学生的急救知识水平都能得到提高。[方法]对我校非医学专业在校大学生干部400名进行培训,培训前后对急救理论知识与急救技能进行评测。[结果]培训前大学生干部对院外急救知识掌握的合格率仅为21．0％,而培训后合格率达到98．7％;培训前对基本院外急救技能掌握的合格率仅为2．7％,而培训后合格率达到92．5％。[结论]对非医学大学生进行院前急救知识和技能培训,能有效提高非医学大学生自我保护意识和院外现场急救水平。     

军队医院护士急救技能培训的探讨

目的探讨军队医院护师和急诊科护士急救技能培训的方法。方法2005年4月至9月,对91名护理人员（所有科室的护师65名,急诊科护士26名）实施急救护理技能的专科培训,并比较培训前后的考核成绩。结果专科培训前后,护理人员急救理论知识及急救技能的考核合格率有显著性差异（P＜0．01）。结论加强岗位培训、巩固专科护理知识、建立抢救流程有助于提高护士的救护水平,适应现代急救技术及现代战场的需要。     

海岛基层医护人员急救知识与技能培训及效果评价

总结对海岛基层医护人员进行急救知识和技能培训的效果。采用多样式培训方法对89名基层医护人员进行急救知识和技能培训，并经理论知识及心肺复苏技能考核评价培训效果。培训前急救知识和急救技能合格率为39．3％和36．0％，培训后为95．5％和97．8％，有显著提高。     

对中学生进行心肺复苏技能培训的方法与效果

目的探讨对中学生进行心肺复苏知识和技能培训的方法及意义。方法采用多种培训形式相结合的方法对不同年级的200名中学生进行心肺复苏技能培训,在培训前后对中学生心肺复苏知识和技能进行测评。结果200名中学生普遍缺乏心肺复苏知识和技能,通过培训,心肺复苏理论知识考核合格率从培训前7％上升到94．5％,差异有统计学意义（P〈0．05）;心肺复苏操作考核合格率达100％;低年级与高年级的中学生培训后心肺复苏技能考核首次合格率比较,差异无统计学意义（P〉0．05）。结论中学生心肺复苏知识普遍缺乏,建议从初中生抓起,将急救知识及技能纳入九年义务教育课程体系,合适的培训方法能有效地提高中学生心肺复苏技能,同时,争取行政支持,学校与医院联合培训是普及中学生心肺复苏技能的有效途径。     

年龄分层培训方法在中小学生急救培训中的应用

目的探讨年龄分层培训方法在中小学生急救培训中的应用效果。方法采用方便抽样法抽取1 458名中小学生,按照年龄进行分层并设置培训课程,对急救相关知识与技能进行普及培训;比较培训前后学生急救知识得分及急救技能的合格率。结果培训后低年级和高年级组学生各项急救知识得分及急救技能合格率均得到提高。结论年龄分层培训方法根据学生各年龄段的特点设置急救培训课程内容,同时借助多样化教学方法和手段,使中小学生急救意识与技能得到提高。     

非医学大学生干部急救知识和技能培训效果分析

[目的]对我校非医学大学生干部进行院前急救知识培训,力争做到以点带面,使每个学生的急救知识水平都能得到提高.[方法]对我校非医学专业在校大学生干部400名进行培训,培训前后对急救理论知识与急救技能进行评测.[结果]培训前大学生干部对院外急救知识掌握的合格率仅为21.0%,而培训后合格率达到98.7%;培训前对基本院外急救技能掌握的合格率仅为2.7%,而培训后合格率达到92.5%.[结论]对非医学大学生进行院前急救知识和技能培训,能有效提高非医学大学生自我保护意识和院外现场急救水平.     

培训警务人员心肺复苏技能的方法及意义

目的探讨对警务人员进行心肺复苏知识和技能培训的方法和意义。方法采用问卷调查与培训相结合的方式,对不同警种的91名警务人员进行心肺复苏知识和技能的调查培训。结果培训前91名警务人员普遍缺乏心肺复苏知识和技能;通过培训,理论考核合格率从培训前的13.19%上升到94.51%,差异有显著性意义(P<0.01),心肺复苏操作考核合格率达100%。结论医院培训是提高警务人员心肺复苏知识与技能的一种有效方法;拓展了护理工作的服务领域,为护士走进社区普及急救知识和技能奠定了基础。     

对工厂工人进行心肺复苏技能培训的方法及效果评价

目的探讨对工厂工人进行心肺复苏知识和技能培训的方法及其效果。方法采用多种培训形式相结合的方法对不同工厂426名工人进行心肺复苏技能培训，对培训前后工人进行心肺复苏知识测评。结果培训前426名工人普遍缺乏心肺复苏技能，通过培训，心肺复苏操作考核合格率从培训前的9．6％提高到91．3％，差异有统计学意义（P〈0．01）。结论工厂工人普遍缺乏心肺复苏知识，运用合适的培训方法能有效提高工人心肺复苏技能。针对我国国情，医院培训是普及心肺复苏技能的理想场所。     

深圳大学城社区内开展急救知识和技能培训效果分析

[目的]探讨社康中心对社区居民进行心肺复苏知识和技能培训的方法,提高急救知识和操作技能水平。[方法]对深圳大学城社区93名师生进行急救知识和心肺复苏操作技能培训,并在培训前后进行评价。[结果]培训后急救知识和操作技能合格率与培训前比较,差异均有统计学意义(P<0.01)。[结论]对社区居民进行急救知识和心肺复苏操作技能培训,能有效普及社区居民的急救知识和技能水平。     

深圳大学城社区内开展急救知识和技能培训效果分析

[目的]探讨社康中心对社区居民进行心肺复苏知识和技能培训的方法，提高急救知识和操作技能水平。[方法]对深圳大学城社区93名师生进行急救知识和心肺复苏操作技能培训，并在培训前后进行评价。[结果]培训后急救知识和操作技能合格率与培训前比较，差异均有统计学意义（P〈0.01）。[结论]对社区居民进行急救知识和心肺复苏操作技能培训，能有效普及社区居民的急救知识和技能水平。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.